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Rabu, 28 Mei 2014

WellPoint Begins New Oncology Program For Providers Offering Doctors $350 Monthly Payment For Each Patient Treated Using Insurers Recommendations - Is This A Kickback Offer?

The program does not begin until July and is somewhat of a pilot I guess you could say as it will only be available in 6 states but more states added later. Breast cancer, lung and colorectal cancer will be the initial focuses and more types of cancer added later too. Back in 2010 United sent out letters “grading” doctors on their treatments and you can review that at the link below.

This is a tough decision as cancer treatments change frequently so will the “recommended” program change with it? We already have narrow networks for doctors so will this be narrowed drugs for cancer patients too? Some of the comments here seemed to reflect that it is workable from a few cancer treatment centers, but I guess it’s a wait and see overall.

This almost looks like a “kickback” type of situation does it not? At any rate oncologists have a high up front cost with buying and storing some of the drugs as well and insurers know this as well so the $350 would be an incentive to help in that cost. We know insurers are hiring more quants to create new types of business models and this sounds like it could one of those created.

Insurers are changing how they pay for cancer care, aiming to blunt rapidly growing costs and push oncologists to adhere to standardized treatment guidelines.

The largest effort yet is set to be unveiled by WellPoint Inc., WLP -0.31% which will begin offering oncologists a $350-per-month payment for each patient who is on one of the insurer's recommended regimens. WellPoint, the No. 2 insurer in the U.S., will roll out its new program July 1 in six states and through its entire network by the middle of next year. Initially, it will focus on breast, lung and colorectal cancer, but it will expand to other forms of the disease.

Programs like WellPoint's and others around the country are part of an effort to smooth out wide variations in how doctors treat patients, which health experts say can be wasteful and don't always benefit patients. In cancer, insurers and health-care providers have been developing treatment protocols—sometimes known as "pathways"—that are supposed to represent the best and most efficient approaches, balancing cost, benefit and side effects. Insurers are then paying doctors according to how well they comply.